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Kim SK, Hwang YS, Ock M, Jo HS. Development of Items for Transitional Care Service and Outcome Indicators of Discharged Patients for Improvement in Quality of Care. J Korean Med Sci 2023; 38:e246. [PMID: 37582496 PMCID: PMC10427215 DOI: 10.3346/jkms.2023.38.e246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/11/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND In this study, with the aim of improving the quality of transitional care service for discharged patients, the Health Care Quality and Outcomes Indicators of the Organization for Economic Co-operation and Development and National Health Service Outcomes Framework of the UK were applied to derive service items for provision and develop evaluation indicators under categories of effectiveness, safety, and patient-centeredness. METHOD A scoping review was conducted to derive core concepts and evidence materials/data for transitional care service. For the derived items of transitional care service and evaluation indicators, a three-round Delphi study was conducted with experts in the fields of healthcare/medicine/nursing/social welfare. RESULTS First, as a result of the scoping review, components of transitional care service (assessment of need by period of transitional care service, multi-professional team, connection to community resources, etc.) and themes for outcome indicators (effectiveness, patient safety, patient-centeredness) were derived. Second, by classifying the items for assessment according to the hospitalization and transition period and conducting a Delphi study to derive service items for transitional care service, during the hospitalization period, presence/absence of a caregiver and need for a caregiver, activities of daily living, and necessity for home-based care services were identified as items of high priority. Regarding patient safety, risk of falls and fractures during hospitalization, and necessity for medication reconciliation were identified as the items of high importance. For the transition period, provision of education regarding adequate responses and handling of emergencies, provision of information and guidance on application of services for basic livelihood security program beneficiaries, and education for patient skills in self-management of health were derived as items of high priority. Third, for the derivation of outcome indicators for transitional care service, in the "effectiveness" category, the experts rated a reduction in the 30-day readmission rate as an item of high importance along with a decrease in emergency department visits, reduction in preventable admissions as indicators of high relevance. In terms of "patient safety," a decrease in drug adverse reactions, and reduction in the incidence of falls and pressure ulcers were identified as indicators of high priority. Finally, for the category of "patient-centeredness," patient experience assessment, level of service satisfaction reported by patients and their caregivers, and reducing burden on caregivers were identified as indicators of high priority. CONCLUSION This study suggest practical implications for the service with high relevance and necessity for transitional period. It also presented outcome indicators of transitional care service to contribute toward an improvement in the quality of care.
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Affiliation(s)
- Su Kyoung Kim
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yu Seong Hwang
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Heui Sug Jo
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon, Korea.
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Tyrańska-Fobke A, Robakowska M, Ślęzak D, Pogorzelczyk K, Basiński A. Searching for the Optimal Method of Financing Hospital Emergency Departments-Comparison of Polish and Selected European Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031507. [PMID: 35162526 PMCID: PMC8835359 DOI: 10.3390/ijerph19031507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023]
Abstract
Hospital emergency departments are units of the State Medical Rescue system in Poland, which was established to help people in a state of a health emergency. The aim of this study is to develop an optimal method of financing emergency departments in Poland. The study used Polish data from 2016–2019 on the financing of services at the Clinical Emergency Department of the University Clinical Center in Gdańsk. For benchmarking and mathematical modeling, data for the Czech Republic, Germany and Latvia was used. The results of the analysis shows significant differences, to the disadvantage of Clinical Emergency Department, between the potential contract values in the tested models and the actual amounts of funds transferred by the National Health Fund Pomeranian Voivodeship Branch for the activities of Clinical Emergency Department under the concluded contracts. The introduction of co-payment on the part of patients reporting to the emergency departments with minor ailments that do not require hospitalization generates financial revenues, but does not significantly improve the financial results of the analyzed ward. However, it may be educational for patients in terms of raising their awareness of the correct place to seek assistance in the event of a sudden illness.
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Affiliation(s)
- Anna Tyrańska-Fobke
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
- Correspondence: (A.T.-F.); (D.Ś.)
| | - Marlena Robakowska
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Daniel Ślęzak
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
- Correspondence: (A.T.-F.); (D.Ś.)
| | | | - Andrzej Basiński
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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Cook NL, Clauser SB, Shifreen A, Parry C. Reconceptualizing Care Transitions Research From the Patient Perspective. Med Care 2021; 59:S398-S400. [PMID: 34228022 PMCID: PMC8263134 DOI: 10.1097/mlr.0000000000001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sui X. Comprehensive nursing care on the psychological states, quality of life, and serum indexes of NSCLC patients with TCM combined with chemotherapy. Am J Transl Res 2021; 13:8458-8464. [PMID: 34377343 PMCID: PMC8340190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To study the effect of comprehensive nursing care on the psychological status, quality of life, and serum indicators of non-small cell lung cancer (NSCLC) patients undergoing traditional Chinese medicine (TCM) and chemotherapy. METHODS Ninety-two patients with NSCLC admitted to this hospital between January 2018 and June 2020 were recruited for this study. All the patients underwent combined Chinese medicine chemotherapy. The control group underwent conventional nursing care, and the observation group underwent comprehensive nursing. The clinical efficacy, lung function, serum indexes, quality of life, and psychological states of the two groups, their adverse reactions during the treatment period, and the patients' satisfaction with the nursing work were compared. RESULTS The overall efficacy of the observation group was better in comparison with the control group. After the treatment, the PEF, FVC, and FEV1 levels in the observation group were higher than they were in the control group. After the treatment, the physical functioning, role functioning, emotional functioning, social functioning, and overall health scores in the observation group were higher than they were in the control group. The serum IL-6, TNF-α, and MMP-9 levels in the observation group were lower than they were in the control group. Regarding the incidence of nausea, vomiting, and diarrhea, the observation group had a lower incidence. In terms of of the total satisfaction rate, the observation group was better than the control group (97.83% vs 82.61%), and the differences were all statistically significant (P<0.05). CONCLUSION Comprehensive nursing can help improve the clinical efficacy of TCM combined with chemotherapy, reduce the serum indicator expression levels, improve the patients' mental states and quality of life, improve patient satisfaction, and reduce the incidence of adverse reactions.
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Affiliation(s)
- Xin Sui
- Xingtai People's Hospital Xingtai, China
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5
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King PK, Burkhardt C, Rafferty A, Wooster J, Walkerly A, Thurber K, Took R, Masterson J, St. Peter WL, Furuno JP, Williams E, Ferren J, Rascon K. Quality measures of clinical pharmacy services during transitions of care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Roxane Took
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | - Jon P. Furuno
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Evan Williams
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Janie Ferren
- American College of Clinical Pharmacy Lenexa Kansas USA
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Beauchet O, Lubov J, Galery K, Afilalo M, Launay CP. Emergency room evaluation and recommendations for older emergency department users: results of the ER 2 experimental study. Eur Geriatr Med 2021; 12:921-929. [PMID: 34089148 DOI: 10.1007/s41999-021-00517-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The study aims to examine whether the use of "emergency room evaluation and recommendations" (ER2) tool in daily ED practice reduces the length of stay in ED and hospital, and hospital admission in older patients visiting ED on stretcher. METHODS A total of 3931 older patients visiting ED of the Jewish General Hospital (Montreal, Quebec, Canada) on stretcher were recruited in this non-randomized, pre-post intervention, single arm, prospective and longitudinal open-label trial. ED staff and patients were blinded of the ER2 score and patients received usual ED care over the observational phase, whereas ED staff were informed about the ER2 score and patients had usual care plus interventions based on tailor-made geriatric recommendations during the interventional phase. The length of stay in ED and in hospital, and hospital admission were the outcomes. RESULTS The ER2 recommendations were associated with increased length of stay in ED (β = 2.94 with P ≤ 0.001) and decreased length of stay in hospital (β = - 2.07 with P = 0.011). No effect was found for hospital admission (Odd Ratio (OR) = 0.92 with P = 0.182). CONCLUSION Emergency room evaluation and recommendations (ER2) tool had mixed effects. Shorter hospital stay has been reported for older ED users hospitalized, but increased ED stay and no effects on hospital admission were found.
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Affiliation(s)
- Olivier Beauchet
- Department of Medicine, University of Montreal, Montreal, QC, Canada. .,Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada. .,Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Joshua Lubov
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - Kevin Galery
- Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada
| | - Marc Afilalo
- Emergency Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Cyrille P Launay
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
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Launay CP, Lubov J, Galery K, Vilcocq C, Maubert É, Afilalo M, Beauchet O. Prognosis tools for short-term adverse events in older emergency department users: result of a Québec observational prospective cohort. BMC Geriatr 2021; 21:73. [PMID: 33482740 PMCID: PMC7821522 DOI: 10.1186/s12877-020-01999-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/29/2020] [Indexed: 01/02/2023] Open
Abstract
Background The “Program of Research on the Integration of Services for the Maintenance of Autonomy” (PRISMA-7) and “Emergency room evaluation and recommendations” (ER2) are both clinical tools used in Québec Emergency Departments (EDs) for screening of older ED users at higher risk of poor outcomes, such as prolonged length of stay (LOS) in EDs and in hospital. The study aimed to: 1) examine whether the PRISMA-7 and ER2 risk levels were associated with length of stays in ED and hospital, as well as hospital admission; and 2) compare the criteria performance (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under receiver operating characteristic curve) of the PRISMA-7 and ER2 high-risk levels for these three ED adverse events in Québec older patients visiting ED on a stretcher. Methods A total of 1905 older patients who visited the ED of the Jewish General Hospital (Montreal, Québec, Canada) on stretchers were recruited in this prospective observational cohort. Upon their ED arrival, PRISMA-7 and ER2 were performed. The outcomes were LOS in ED and in hospital, and hospital admission. Results The PRISMA-7 and ER2 risk levels were associated with length of stay in ED and hospital as well as with hospital admission. Prolonged stays and higher hospitalization rates were associated with high-risk levels, whereas those in low-risk level groups had significantly shorter LOS and a lower rate of hospital admission (P < 0.006). While performance measures were poor for both assessment tools, ER2 had a greater prognostic testing accuracy compared with PRISMA-7. Conclusion PRISMA-7 and ER2 were both associated with incidental short-term ED adverse events but their overall prognostic testing accuracy was low, suggesting that they cannot be used as prognostic tools for this purpose.
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Affiliation(s)
- Cyrille P Launay
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada. .,Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada.
| | - Joshua Lubov
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada
| | - Kevin Galery
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada.,Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada
| | - Christine Vilcocq
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada.,Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada
| | - Éric Maubert
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada.,Centre of Excellence on Longevity of McGill Integrated University Health and Social services Network, Quebec, Canada
| | - Marc Afilalo
- Emergency Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada.,Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Indonesia
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8
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Improving Use of a Hospital Transitional Care Clinic. Jt Comm J Qual Patient Saf 2020; 46:673-681. [DOI: 10.1016/j.jcjq.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
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9
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Taylor YJ, Roberge J, Rossman W, Jones J, Generoso C, Bobay C, DeSilva B, Evans C, Pracht M, Dulin MF, Davis CJ. A Population Health Approach to Transitional Care Management for High-Risk Patients with Diabetes: Outcomes at a Rural Hospital. Popul Health Manag 2019; 23:278-285. [PMID: 31765271 DOI: 10.1089/pop.2019.0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patient transitions from inpatient to home care are an important area of focus for reducing costly unplanned hospital readmissions. In rural settings, the challenge of reducing unplanned readmissions is amplified by limited access to both ambulatory and acute care as well as high levels of social disadvantage. In addition, there is a scarcity of evidence regarding strategies that have been proven to improve care transitions and related patient outcomes in this setting. This paper describes the process for implementation and results of a telephone-based transitional care management (TCM) program designed to reduce readmissions for patients with diabetes in a rural hospital in Scotland County, North Carolina. Data were collected from July 2016 to January 2019 using billing records to identify adult patients with high or very high risk of readmission based on length of stay, acuity, comorbidity, and emergency department visits (LACE) scores. Care managers contacted eligible patients by phone after discharge to review discharge instructions, assess need for home health services and transportation assistance, and schedule primary care follow-up visits. Overall, 13.8% of 15,271 discharges were targeted for TCM; 68.2% of these involved a patient with diabetes. The post-intervention 30-day readmission rate was 18.0% among patients identified as high or very high risk versus 8.8% among the overall population and did not differ significantly between TCM participants with diabetes and those without (22.9% vs.18.8%; P = 0.525). Findings highlight challenges with implementing transition of care interventions in rural settings, which include staffing, patient volume, and accessing data from out-of-network providers.
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Affiliation(s)
- Yhenneko J Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Jason Roberge
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Whitney Rossman
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer Jones
- Scotland Health Care System, Laurinburg, North Carolina, USA
| | | | - Cindy Bobay
- Care Management, Atrium Health, Mint Hill, North Carolina, USA
| | - Barbara DeSilva
- Care Management, Atrium Health, Mint Hill, North Carolina, USA
| | - Constance Evans
- Information and Analytics Services, Atrium Health, Charlotte, North Carolina, USA
| | - Matthew Pracht
- Scotland Health Care System, Laurinburg, North Carolina, USA
| | - Michael F Dulin
- Academy for Population Health Innovation, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Cheryl J Davis
- Scotland Health Care System, Laurinburg, North Carolina, USA
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Opening up disruptive ways of management in cancer pain: the concept of multimorphic pain. Support Care Cancer 2019; 27:3159-3170. [PMID: 31093768 DOI: 10.1007/s00520-019-04831-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Following a series of articles reviewing the basics of cancer pain management, in this article, we develop the guiding principle of our philosophy: the concept of multimorphic pain and how to integrate it as the innovative cornerstone of supportive care in cancer. METHOD Critical reflection based on literature analysis and clinical practice. RESULTS This model aims to break with standard approaches, offering a more dynamic and exhaustive vision of cancer pain as a singular clinical entity, taking into account its multimorphic characteristics (cancer pain experience can and will change during cancer: aetiology, physiopathology, clinical presentation and consequences of pain) and the disruptive elements that can occur to influence its evolution (cancer evolution, concomitant treatments, pain from associated diseases, comorbidities and complications, or modifications in the environment). Our model establishes the main key stages for interdisciplinary management of cancer pain: Early, personalised management that is targeted and multimodal; Identification, including in advance, of potential disruptive elements throughout the care pathway, using an exhaustive approach to all the factors influencing pain, leading to patient and caregiver education; Optimal analgesic balance throughout the care pathway; Integration of this concept into a systemic early supportive care model from the cancer diagnosis. CONCLUSIONS Given the difficulties still present in the management of pain in cancer, and whilst cancer is often considered as a chronic condition, the concept of multimorphic pain proposes a practical, optimised and innovative approach for clinicians and, ultimately, for patients experiencing pain.
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Prediction of unplanned hospital admissions in older community dwellers using the 6-item Brief Geriatric Assessment: Results from REPERAGE, an observational prospective population-based cohort study. Maturitas 2019; 122:1-7. [PMID: 30797525 DOI: 10.1016/j.maturitas.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/07/2018] [Accepted: 01/03/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The 6-item Brief Geriatric Assessment (BGA) provides a priori risk stratification of incident hospital health adverse events, but it has not been used yet to assess the risk of unplanned hospital admission for older patients in primary care. This study aims to examine the association between the a priori risk stratification levels of the 6-item BGA performed by general practitioners (GPs) and incident unplanned hospital admissions in older community patients. METHODS Based on an observational prospective cohort design, 668 participants (mean age 84.7 ± 3.9 years; 64.7% female) were recruited by their GPs during an index primary care visit. The 6-item BGA was completed at baseline and provided an a priori risk stratification in three levels (low, moderate, high). Incident unplanned hospital admissions were recorded during a 6-month follow-up. RESULTS The incidence of unplanned hospital admissions increased with the risk level of the 6-item BGA stratification, the highest prevalence (35.3%) being reported with the high-risk level (P = 0.001). The risk of unplanned hospital admission at the high-risk level was significant (crude odds ratio (OR) = 5.48, P = 0.001 and fully adjusted OR = 3.71, P = 0.032, crude hazard ratio (HR) = 4.20; P = 0.002 and fully adjusted HR = 2.81; P = 0.035). The Kaplan-Meier's distributions of incident unplanned hospital admissions differed significantly between the three risk levels (P-value = 0.002). Participants with a high-risk level were more frequently admitted to hospital than those at a low-risk level (P = 0.001). Criteria performances of all risk levels were poor, except the specificity of the high-risk level, which was 98.2%. CONCLUSIONS The a priori 6-item BGA risk stratification was significantly associated with incident unplanned hospital admissions in primary care older patients. However, except for the specificity of the high-risk level, its criteria performances were poor, suggesting that this tool is unsuitable for screening older patients in primary care settings at risk of unplanned hospital admission.
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12
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Launay CP, Kabeshova A, Lanoé A, Chabot J, Levinoff EJ, Beauchet O. Age effect on the prediction of risk of prolonged length hospital stay in older patients visiting the emergency department: results from a large prospective geriatric cohort study. BMC Geriatr 2018; 18:127. [PMID: 29843649 PMCID: PMC5975659 DOI: 10.1186/s12877-018-0820-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the rapid growth of elderly patients visiting the Emergency Department (ED), it is expected that there will be even more hospitalisations following ED visits in the future. The aim of this study was to examine the age effect on the performance criteria of the 10-item brief geriatric assessment (BGA) for the prolonged length of hospital stay (LHS) using artificial neural networks (ANNs) analysis. METHODS Based on an observational prospective cohort study, 1117 older patients (i.e., aged ≥ 65 years) ED users were admitted to acute care wards in a University Hospital (France) were recruited. The 10-items of BGA were recorded during the ED visit and prior to discharge to acute care wards. The top third of LHS (i.e., ≥ 13 days) defined the prolonged LHS. Analysis was successively performed on participants categorized in 4 age groups: aged ≥ 70, ≥ 75, ≥ 80 and ≥ 85 years. Performance criteria of 10-item BGA for the prolonged LHS were sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic curve [AUROC]). The ANNs analysis method was conducted using the modified multilayer perceptron (MLP). RESULTS Values of criteria performance were high (sensitivity> 89%, specificity≥ 96%, PPV > 87%, NPV > 96%, LR+ > 22; LR- ≤ 0.1 and AUROC> 93), regardless of the age group. CONCLUSIONS Age effect on the performance criteria of the 10-item BGA for the prediction of prolonged LHS using MLP was minimal with a good balance between criteria, suggesting that this tool may be used as a screening as well as a predictive tool for prolonged LHS.
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Affiliation(s)
- C P Launay
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - A Kabeshova
- Department of Neuroscience, Division of Geriatric Medicine Angers University Hospital, Angers, France
| | - A Lanoé
- Department of Neuroscience, Division of Geriatric Medicine Angers University Hospital, Angers, France
| | - J Chabot
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for medical research, McGill University, Montreal, QC, Canada
| | - E J Levinoff
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for medical research, McGill University, Montreal, QC, Canada
| | - O Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for medical research, McGill University, Montreal, QC, Canada.,Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Centre of Excellence on Aging and Chronic Diseases of McGill University Health Network, Montreal, QC, Canada
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